目的: 探讨Rotarex减容结合药物涂层球囊处理股浅动脉支架内再狭窄的临床疗效。方法: 回顾性分析2016年6月至2018年6月我院收治的19例股浅动脉支架内再狭窄病人,均行Rotarex结合药物涂层球囊治疗。术后 3、6、12 个月随访,多普勒超声检查靶动脉。结果: 19例病人均成功完成Rotarex减容结合药物涂层球囊治疗。全部随访(13.5±6.1)个月。超声检查提示,再通后6个月一期通畅率100%,12个月一期通畅率84.2%(16/19),12个月免于干预率89.5%(17/19)。随访期间无死亡及截肢事件发生。结论: Rotarex减容结合药物涂层球囊治疗股浅动脉支架内再狭窄安全有效。
Objective To evaluate the efficacy of Rotarex debulking combined with drug coated balloon (DCB) in the treatment of superficial femoral artery in-stent restenosis(ISR). Methods Nineteen patients with superficial femoral artery ISR treated with Rotarex combined with DCB were analyzed retrospectively in our hospital from June 2016 to June 2018. Postoperative follow-up was carried out for 3, 6 and 12 months with Doppler ultrasound examination. Results All 19 patients were treated successfully by Rotarex debulking with DCB and were followed up (13.5+6.1) months. Ultrasonography showed that patency was 100% in the first 6 months and 84.2% (16/19) in the first 12 months. No revascularization was found 89.5% (17/19) in 12 months. Mortality and amputation did not occur during the follow-up period. Conclusions Combination Rotarex debulking with DCB could be safe and effective in the treatment of superficial femoral artery ISR.
[1] Tosaka A, Soga Y, Iida O, et al.Classification and clinical impact of restenosis after femoropopliteal stenting[J]. J Am Coll Cadiol,2012,59(1):16-23.
[2] Krishnan P, Tarricone A, K-Raman P, et al.Intravascular ultrasound guided directional atherectomy versus directional atherectomy guided by angiography for the treatment of femoropopliteal in-stent restenosis[J]. Ther Adv Cardiovasc Dis,2018,12(1):17-22.
[3] Srimurugan B, Sigler M, Sankar NM, et al.In-stent restenosis: surgical and histopathological perspective[J]. Asian Cardiovasc Thorac Ann,2018,26(2):114-119.
[4] Manzi M, Cester G, Palena LM, et al.Paclitaxel-coated balloon angioplasty for lower extremity revascularization: A new way to fight in-stent restenosis[J]. J Cardiovasc Surg (Torino),2010,51(4):567-571.
[5] 符伟国, 岳嘉宁. 股腘动脉段病变支架内再狭窄的腔内治疗策略分析[J]. 中华外科杂志,2016,54(8):586-590.
[6] Schillinger M, Sabeti S, Dick P, et al.Sustained benefit at 2 years of primary femoropopliteal stenting compared with balloon angioplasty with optional stenting[J]. Circulation,2007,115(21):2745-2749.
[7] Laird JR, Katzen BT, Scheinert D, et al.Nitinol stent implantation vs. balloon angioplasty for lesions in the superficial femoral and proximal popliteal arteries of patients with claudication: three-year follow-up from the RESILIENT randomized trial[J]. J Endovasc Ther,2012,19(1):1-9.
[8] 王恒振, 魏争, 刘冰. 股动脉支架内再狭窄的腔内治疗进展[J]. 中国血管外科杂志(电子版),2016,8(1):93-96.
[9] 庄金满, 李选. 下肢动脉硬化闭塞症的治疗进展[J]. 中国微创外科杂志,2014,14(9):839-843.
[10] Block PC, Fallon JT, Elmer D, et al.Experimental angioplasty: lessons from the laboratory[J]. Am J Roentgenol,1980,135(5):907-912.
[11] Kinney TB, Chin AK, Rurik GW, et al.Transluminal angioplasty: a mechanical-pathophysiological correlation of its physical mechanisms[J]. Radiology,1984,153(1):85-89.
[12] Dick P, Sabeti S, Mlekusch W, et al.Conventional balloon angioplasty versus peripheral cutting balloon angioplasty for treatment of femoropopliteal artery in-stent restenosis: initial experience[J]. Radiology,2008,248(1):297-302.
[13] Al Shammeri O, Bitar F, Ghitelman J, et al.Viabahn for femoropopliteal in-stent restenosis[J]. Ann Saudi Med,2012,32(6):572-582.
[14] Leopardi M, Houbballah R, Becquemin JP.Effectiveness of Zilver PTX eluting stent in TASC C/D lesions and restenosis[J]. J Cardiovasc Surg (Torino),2014,55(2):229-234.
[15] Murata N, Takahara M, Soga Y, et al.Drug-eluting stent vs percutaneous transluminal angioplasty for treatment of femoropopliteal in-stent restenosis: results from a retrospective 1-year multicenter study[J]. J Endovasc Ther,2016,23(4):642-647.
[16] Schmidt A, Zeller T, Sievert H, et al.Photoablation using the turbo-booster and excimer laser for in-stent restenosis treatment: twelve-month results from the PATENT study[J]. J Endovasc Ther,2014,21(1):52-60.
[17] Shammas NW, Shammas GA, Jerin M, et al.Differences in patient selection and outcomes between SilverHawk atherectomy and laser ablation in the treatment of femoropopliteal in-stent restenosis: a retrospective analysis from a single center[J]. J Endovasc Ther,2013,20(6):844-852.
[18] Laird JR Jr, Yeo KK, Rocha-Singh K, et al.Excimer laser with adjunctive balloon angioplasty and heparin-coated self-expanding stent grafts for the treatment of femoropopliteal artery in-stent restenosis: twelve-month results from the SALVAGE study[J]. Catheter Cardiovasc Interv,2012,80(5):852-859.
[19] Shammas NW, Shammas GA, Arikat L, et al.Five-year freedom from target-lesion revascularization using excimer laser ablation therapy in the treatment of in-stent restenosis of femoropopliteal arteries[J]. J Invasive Car-diol,2017,29(6):207-208.
[20] Krankenberg H, Tübler T, Ingwersen M, et al.Drug-coa-ted balloon versus standard balloon for superficial femoral artery in-stent restenosis: the randomized femoral artery in-stent restenosis(FAIR) trial[J]. Circulation,2015, 132(23):2230-2236.
[21] Liistro F, Angioli P, Porto I, et al.Paclitaxel-eluting balloon vs. standard angioplasty to reduce recurrent restenosis in diabetic patients with in-stent restenosis of the superficial femoral and proximal popliteal arteries: the DEBATE-ISR study[J]. J Endovasc Ther,2014,21(1):1-8.
[22] Heller S, Lubanda J, Varejka P, et al.Percutaneous mechanical thrombectomy using Rotarex® S device in acute limb ischemia in infrainguinal occlusions[J]. Biomed Res Int,2017,2017:2362769.
[23] Stanek F, Ouhrabkova R, Prochazka D, et al.Mechanical thrombectomy using the Rotarex catheter in the treatment of acute and subacute occlusions of peripheral arteries: immedite results, long-term follow-up[J]. Int Angiol,2013, 32(1):52-60.
[24] Duc SR, Schoch E, Pfyffer M, et al.Recanalization of acute and subacute femoropopliteal artery occlusions with the rotarex catheter: one year follow-up, single center experience[J]. Cardiovasc Intervent Radiol,2005,28(5):603-610.